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Dr Zafar Ikram Programme Manager- MNCH Punjab

Though early marriages are the most important reason for the maternal health issues yet the only panacea for this purpose is awareness. And, it comes only through education, and involvement, of women in the training campaigns.

Jahangir’s World Times (JWT): What is Maternal Neonatal and Child Health (MNCH) programme and how it is beneficial for Pakistan?

Dr Zafar Ikram (DZI): The Maternal Neonatal and Child Health (MNCH) programme basically focuses on health-related issues faced by mothers and newborns in Pakistan, and when I talk about ‘newborn’, I actually mean the child up to the age of five years. The programme is specifically aimed at eradication of natal diseases and the maximum possible decrease in mortality rate among newborns or mothers during the birth process.

The programme was launched in 2007 and was designed, especially, to focus on the ‘MDGs 4 and 5’ which we, as a nation, ought to achieve by the year 2015.

JWT: What are the major issues related to maternal health in Pakistan and how we are coping with them?

DZI: The most pressing issue related to mothers is the maternal mortality ratio that is very high in comparison with other countries in the region. A number of factors can be enumerated as the main reasons behind this state of affairs. As you know, a huge chunk of our population lives in rural areas and they have to face a number of socio-cultural problems. Lack of education makes the fundamental reason of prevailing unawareness among rural masses as far as health is concerned. In addition, absence of skilled medical staff, polluted environment and lack of adequate resources in critical cases are also some most common factors responsible for deaths during pregnancy or childbirth. Moreover, we have to cope with malnutrition as well because it is playing havoc with the health of children and expectant mothers. Thus, these issues of maternal health and the factors responsible for them need to be dealt with on a war-footing.

JWT: What would you say on the use of traditional method of childbirth in Pakistan?

DZI: Yes, it is a fact that even today in Pakistan nearly 50 to 60 per cent deliveries are handled by the traditional midwives. However, to me, the delivery at home is okay, but it is actually the midwife’s handling of the whole process that makes it a risky and dangerous affair. Now with our MNCH programme, we are gradually inducting professionally-trained medical staff called ‘Community Midwives’. We recruited them through a merit-based process and afterwards trained them in Midwife Training Schools attached to the District Headquarters Hospitals. This 18-month training programme consists of both theory and practical. After the final exam, a successful lady appears before the District Evaluation Committee which, after necessary assessment of her knowledge, issues her a certificate of community Midwife and then she is allowed to conduct normal deliveries. Now, encouragingly, the number of deliveries conducted by the skilled birth attendants has seen a huge rise between 2007 and 2011. In fact, it has increased from 40% to 59%. At present, only 40% deliveries in Punjab are conducted by the unskilled attendants, however, the skilled staff will soon take over this chunk also.

JWT: Some experts opine that early marriage is a major cause of such health issues. Do you agree? And what age do you consider the most suitable for marriage?

DZI: Well, I definitely support this opinion. Though early marriages are the most important reason for the maternal health issues yet the only panacea for this purpose is awareness. And, it comes only through education and involvement of women in the training campaigns. At present, nearly 80% seats in medical colleges are occupied by females so, I am hopeful that these ladies, equipped with medical education and training, will lead the awareness campaign and will also be helpful for the general understanding of such issues. As far as suitable age for marriage is concerned, I believe that the age of 22 years or above is the most suitable.

JWT: There is a general belief in our society that girl should be younger than her husband. Does it have any sound basis?

DZI: Absolutely not! This perception neither has anything to do with the medical reasoning nor is it a scientifically sound statement. It is only a socio-cultural myth present in our society.

JWT: It is generally observed that even the educated class of our society does not talk about family planning issues openly. Why is it so?

DZI: Well, you are absolutely right. I feel that it is so because there are a number of socio-cultural taboos in our society. Religion is also, unknowingly, considered one of them but again I would say that this situation can be changed by giving more and more importance to education. And as far as religion is concerned, I would share my personal experience with you. Recently, I went to Sudan, where religion is a dominating force in the lives of Sudanese people. They have utilized a Quranic verse which translates that “the mother should feed her child for two years” for this purpose. They have related this verse to the intervals between two pregnancies and there religious scholars also support it. So, they have no hesitation in using family planning methods. I think the religious leaders should also play their effective role in making the awareness campaign more fruit ful object-oriented.

JWT: Do late marriages affect the maternal health or delivery process?

DZI:  Yes, there are chances of having complications during pregnancy and delivery if late marriage take place, especially, after 40 years of age.

Would you like to give any message to public through our pages?

We should consider the maternal and newborn’s health as a prime issue because if we have to emerge as a healthy and prosperous nation, we must focus on these issues. This is the only way to become a part of developed nations.


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